2016-11-07T10:01:57-06:00 2015-12-31 350921680 CROWE HORWATH LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2015-01-01 593467282 Hospice Foundation Inc HOSP 8138718111 12470 telecom drive suite 300 temple terrace FL 33637 DAVID J O'NEIL CHIEF FINANCIAL OFFICER 2016-10-18 true NICOLE BENCIK P00756195 3128997000 2015 2017-02-10 21:41:12Z HPH Foundation Kathy Fernandez president & ceo 12470 telecom drive temple terrace FL 33637 10000505 false X hph-hospice.org/donations-special-gifts X 1997 FL THE ORGANIZATION OPERATES TO ADVANCE UNDERSTANDING, PARTICIPATION & SUPPORT OF THE MISSION & PROGRAMS OF HERNANDO-PASCO HOSPICE, INC. & ITS AFFILIATEs, holding our community's sacred trust through sound stewardship. 7 5 0 5 0 0 790967 637562 0 0 971730 367030 130777 38480 1893474 1043072 232925 7289860 0 0 0 14861 0 0 119515 79358 124907 312283 7429628 1581191 -6386556 13201910 6390491 247861 284435 12954049 6106056 THE ORGANIZATION OPERATES TO ADVANCE UNDERSTANDING, PARTICIPATION AND SUPPORT OF THE MISSION AND PROGRAMS OF HERNANDO-PASCO HOSPICE, INC. AND ITS AFFILIATED NON-FOR-PROFIT ORGANIZATIONS, holding our community's sacred trust through sound stewardship. false false 7290763 7289860 0 Hospice Foundation Inc. is a not for profit organization that was formed solely to provide financial support to Hernando-Pasco Hospice, Inc. and is 100% controlled by Chapters Health System, Inc. Hospice Foundation Inc. affiliated with Chapters Health System, Inc. on February 1, 2015. THE ORGANIZATION ACCEPTS DONATIONS FROM THE PUBLIC AND CONDUCTS ITS OWN FUND RAISING ACTIVITIES. THE ORGANIZATION ALSO OPERATES TWO THRIFT STORES, BOTH IN PASCO COUNTY. THE NET PROCEEDS OF THESE VARIOUS ACTIVITIES FLOW TO HERNANDO-PASCO HOSPICE, INC., (hph) TO SUPPORT ITS END-OF-LIFE HOSPICE SERVICES WITHIN HPH'S THREE COUNTY SERVICE AREA. BY DIRECTION OF THE BOARD OF DIRECTORS, ANY REQUESTS RECEIVED FLOW TO A BOARD DESIGNATED ENDOWMENT TO BE INVESTED TO HELP SECURE THE FUTURE OF HPH. 7290763 true true false false false false false false false false true false false false true true false true false false false false false false false false false true false true false false false false false false false false false false false false false true false false false true 9 0 true 0 false false false false false true true false false false false X 7 5 false false true false true true true true true false false true true true true true true false false false FL X DAVID O'NEIL 8138718167 12470 TELECOM DRIVE TEMPLE TERRACE FL 33637 Thomas Barb executive director (partial year) 5.0 40.0 X X 0 576165 66540 Kathy Fernandez PRESIDENT/CEO (partial year) 2.0 48.0 X X 0 726495 150106 Clarence Prevatt Jr chairman 1.5 2.0 X X 0 0 0 Theresa Brock Vice Chair 1.5 2.0 X X 0 0 0 Michael McHugh secretary/treasurer 1.5 2.0 X X 0 0 0 George Germann board member (Partial Year) 1.5 2.0 X 0 0 0 Randall Woodruff Board Member 1.5 2.0 X 0 0 0 0 1302660 216646 0 false true false 0 637562 637562 0 0 0 0 0 208237 208237 0 0 9081479 8922686 158793 0 158793 158793 73227 34747 38480 38480 0 0 0 0 0 1043072 0 0 405510 7289860 7289860 0 0 12404 766 2715 8923 718 35 187 496 1739 87 452 1200 0 0 15231 15231 0 0 0 0 92566 92566 14861 14861 900 900 407 335 72 330 15 46 269 228 228 384 384 0 0 0 0 7429628 7290763 19350 119515 1260 0 7267259 637834 0 0 13162 2147913 0 0 2147913 5626806 3566940 0 0 293423 37804 13201910 6390491 41723 3652 206138 280783 247861 284435 X 12954049 6106056 12954049 6106056 13201910 6390491 X -6386556 -442064 -19373 X X false true X true false X X 1 HERNANDO PASO HOSPICE INC 592217929 9 true 3452628 0 1 3452628 0 true false false false false false false false false false false false false false false true RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2147913 2147913 2147913 GIFT ANNUITY OBLIGATIONS 278700 due to chapters health system, inc. 2083 280783 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote CHS, LPH, GSH, CHC, HPH, HPH Foundation and the Foundation have been recognized by the Internal Revenue Service (IRS) as not-for-profit corporations and are exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code (IRC) and also from state income taxes under the provisions of Chapter 220.13 of the Florida Income Tax Code. Palliative Care, Pharmacy, and Staffing are also deemed to be tax-exempt as limited liability companies with CHS as sole member. CHS and its affiliated entities income tax returns are subject to review and examination by federal, state and local authorities. CHS and its affiliated entities are not aware of any activities that would jeopardize its tax-exempt status. CHS and its affiliated entities are subject to tax on unrelated business income for management fees received but are not aware of any activities that are subject to excise or other taxes. true HERNANDO PASCO HOSPICE INC 12470 telecom drive temple terrace FL 33637 592217929 501(c)(3) 3452628 0 N/A N/A GENERAL SUPPORT HPH REAL ESTATE INC FKA HOSPICE HOLDINGS INC 12470 TELECOM DRIVE suite 300 TEMPLE TERRACE FL 33637 593467283 501(c)(3) 3837232 0 n/a n/a general support 2 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. the organization's sole purpose is to support hernando-pasco hospice, inc, (hoh) a related 501(c)(3) organization. the majority of the board members of the organization are also board members of hph and oversee all allocations of the grant money. X X X false true false false false false false false false Thomas Barb executive director (partial year) 0 238714 0 0 0 337451 0 57842 0 8698 0 642705 0 0 Kathy Fernandez PRESIDENT/CEO (partial year) 0 444427 0 48205 0 233863 0 124329 0 25777 0 876601 0 48205 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation THE PRESIDENT & CEO OF HOSPICE foundation, INC. IS PAID BY CHAPTERS HEALTH SYSTEM, INC. (A RELATED ORGANIZATION). CHS USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEYS OR STUDIES, FORMS 990 OF OTHER ORGANIZATIONS, AND APPROVAL BY THE BOARD OR COMMITTEE TO DETERMINE HER COMPENSATION. HOSPICE foundation , INC. RELIES ON CHS TO ENSURE COMPENSATION IS REASONABLE. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan CHS (a related organization) has a supplemental executive retirement plan (SERP) in which some of the interested persons participate. During 2015, the following payments were made by CHS into the SERP plans of the participants: Kathy Fernandez - $217,480 Thomas Barb - $337,451 Form 990, Part VI, Line 15a PROCESS FOR DETERMINING COMPENSATION OF TOP MANAGEMENT OFFICIAL THE ORGANIZATION ENGAGED AN INDEPENDENT COMPENSATION CONSULTANT TO ASSIST IN ESTABLISHING A COMPENSATION CHARTER THAT DETAILS THE ORGANIZATION'S PROCEDURES FOR SETTING COMPENSATION OF THE CEO AND ALL OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THE COMPENSATION CHARTER ESTABLISHED THE COMPENSATION COMMITTEE, THE INDEPENDENT BODY RESPONSIBLE FOR ESTABLISHING THE COMPENSATION OF THE CEO AND ALL OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THE COMPENSATION COMMITTEE RELIES ON A RECENT COMPENSATION STUDY PERFORMED BY AN INDEPENDENT COMPENSATION CONSULTANT, WHICH IS DONE ON AN ANNUAL BASIS, THAT PROVIDES COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS IN COMPARABLE ORGANIZATIONS TO SUPPORT ITS DECISION-MAKING PROCESS AND REPORTS ITS ACTIVITIES TO THE BOARD OF DIRECTORS AT THE NEXT REGULARLY SCHEDULED MEETING. THE COMPENSATION COMMITTEE ADEQUATELY DOCUMENTS ITS COMPENSATION DETERMINATIONS IN THE MEETING MINUTES ON A TIMELY BASIS. THE CEO OF Hospice foundation INC. IS PAID BY CHAPTERS HEALTH SYSTEM, INC. Form 990, Part VI, Line 15b PROCESS FOR DETERMINING COMPENSATION OF OTHER OFFICERS SEE NARRATIVE FOR PART VI, LINE 15A Form 990, Part VI, Line 1a Delegate broad authority to a committee THE EXECUTIVE COMMITTEE, MADE UP OF THE CHAIRPERSON OF THE BOARD, THE PRESIDENT/CEO, THE VICE CHAIRPERSON OF THE BOARD AND THE SECRETARY, SHALL HAVE ALL THE AUTHORITY OF THE BOARD OF DIRECTORS EXEPT AS MAY BE LIMITED BY FLORIDA LAW AND SUBJECT TO THE APPROVAL F THE SOLE MEMBER. Form 990, Part VI, Line 4 Significant changes to organizational documents in january of 2015, the articles of incorporation were amended to reflect the following changes: - The number of directors; - The length of service of board of trustees. - The composition of the organization's officers. Form 990, Part VI, Line 6 Classes of members or stockholders The Sole Member of the Corporation shall be Hernando-Pasco Hospice, Inc. Any additional members must be elected by the Sole Member. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body The sole member of the corporation, Hernando-Pasco Hospice, Inc. HAS THE AUTHORITY TO APPOINT THE MEMBERS OF THE BOARD. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Without the written approval of the Sole Member, the Corporation shall not: A. Sell, lease, or dispose of assets, merge, combine or otherwise or reorganize with any other entity, convert its corporate structure to another form or enter into any management services agreement; B. ENTER INTO ANY LOAN FACILITY, BORROW ANY FUNDS OR PLEDGE OR HYPOTHECATE ANY OR ALL OF ITS ASSETS AS SECURITY FOR ANY BORROWING; C. CHANGE THE PURPOSE, CHARACTER OR NATURE OF THE CORPORATION'S BUSINESS TO OTHER THAN A TAX-EXEMPT, NOT FOR PROFIT CORPORATION ORGANIZED AND OPERATED EXCLUSIVELY FOR THE BENEFIT AND SUPPORT OF THE TAX-EXEMPT PURPOSES AND MISSION OF THE SOLE MEMBER; D. MAKE ANY CONTRIBUTION OR DISCTRIBUTION OF ASSETS OR PROPERTY TO ANY PERSON OTHER THAN THE SOLE MEMBER; E. AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION; OR F. DISSOLVE, LIQUIDATE OR OTHERWISE CEASE TO EXIST AS A FLORIDA NOT-FOR-PROFIT CORPORATION WHICH IS EXEMPT FROM TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. Form 990, Part VI, Line 11b Review of form 990 by governing body The organization retains an independent tax advisor to assist management in the preparation and review of its IRS Form 990. Prior to filing the return, management and the independent tax advisor review the return and all required schedules with the Compensation Committee of the Board of Directors. The Compensation Committee is composed of independent directors of the Company. Upon completion of its review, the Compensation Committee recommends to the Executive Committee of the Board of Directors that management be authorized to sign and file the return. Under the Company's by laws the Executive Committee has the authority to take this action on behalf of the Board of Directors. A copy of the Form 990 is provided to the full board prior to filing with the IRS and the Executive Committee reports its activities to the Board of Directors on a quarterly basis. Form 990, Part VI, Line 12c Conflict of interest policy Annually, each officer, director and key employee signs an acknowledgement and disclosure form attesting that they have read the Conflict of Interest Policy and agreeing to comply fully with its terms and conditions during their services with Chapters Health System, Inc. (CHS) and Affiliates. They further agree that if, at any time subsequent to the submission of the disclosure form, they become aware of any actual or potential conflict of interest or the information previously submitted becomes inaccurate or incomplete, they will promptly notify the CHS Board of Directors, the President and CEO of Chapters Health System, Inc., and the Hernando Pasco Hospice, Inc.' board of directors. DETERMINATION OF AND REMEDIES FOR CONFLICTS OF INTEREST 1. Disclosure. In connection with any actual or possible conflict of interest, an interested person must disclose the existence of his or her financial interest and must be given the opportunity to disclose all material facts to the Directors (and members of committees) considering the proposed transaction or arrangement. The disclosure shall be made as soon as practicable following the realization by the interested person that an actual or possible conflict of interest exists. Ordinarily, disclosures by interested persons should be to the Chairperson of the Board. When an actual or possible conflict of interest becomes apparent in the course of a Board meeting (or committee meeting), the interested person shall immediately disclose his or her financial interest and related material facts to the presiding Director or officer at such meeting. 2. Determining Whether a Conflict of Interest Exists. After disclosure of the financial interest and all material facts, and after any discussion with the interested person, the interested person shall leave the Board (or committee) meeting while the determination of a conflict of interest is discussed and voted upon. The remaining Board (or committee) members shall decide if a conflict of interest exists. 3. Procedures for Addressing the Conflict of Interest. (a) An interested person who has a conflict of interest may make a presentation at the Board (or committee) meeting, but after such presentation, he or she shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that result in the conflict of interest. The interested person who has a conflict of interest will not be counted as present for determining a majority with respect to the vote on the transaction or arrangement that results in the conflict of interest. (b) The Chairperson of the Board (or committee) shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. (c) After exercising due diligence, the Board (or Committee) shall determine whether CHS and Affiliates can obtain a more advantageous transaction or arrangement with reasonable efforts from a person or business entity that would not give rise to a conflict of interest. (d)If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the Board (or committee) shall determine by a majority vote of the disinterested Directors (or committee members) whether the transaction or arrangement is in the best interest of CHS and Affiliates and for its own benefit and whether the transaction is fair and reasonable to CHS and Affiliates and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination. Violations of the Conflicts of Interest Policy (a) If the Board (or committee) has reasonable cause to believe that an interested person has failed to disclose actual or possible conflicts of interest, it shall inform the interested person of the basis for such belief and afford the interested person an opportunity to explain the alleged failure to disclose. (b) If, after hearing the response of the interested person and making such further investigation as may be warranted under the circumstances, the Board (or committee) determines that the interested person has in fact failed to disclose an actual or possible conflict of interest, it shall take such action as it determines to be appropriate, including corrective and disciplinary action. RECORD OF PROCEEDINGS The minutes of the Board (and each committee) shall contain: 1. The name of each person who disclosed or otherwise was found to have a financial interest in connection with an actual or possible conflict of interest, the nature of the financial interest, any action taken to determine whether a conflict of interest was present, and the Board's (or committee's) decision as to whether a conflict of interest in fact existed. 2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement, the content of the discussion, including any alternatives to the proposed transaction or arrangement, and a record of any votes taken in connection therewith. PERIODIC REVIEWS To ensure that CHS and Affiliates operate in a manner consistent with their charitable purposes and that it does not engage in activities that could jeopardize their status as organizations exempt from federal income tax, periodic reviews shall be conducted. CHS and Affiliates may, but need not, use an outside advisor to conduct a periodic review. The periodic review shall include, at a minimum, the following subjects: 1. Whether compensation arrangements and benefits are reasonable and are the results of arm's-length bargaining. 2. Whether agreements to provide health care and agreements with other health care providers, employees and third party payers further the charitable purposes of CHS and Affiliates and do not result in private inurement or impermissible private benefit. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE FILED WITH AND VIEWABLE BY THE PUBLIC AT THE OFFICIAL WEBSITE OF THE FLORIDA DEPARTMENT OF STATE, DIVISION OF CORPORATIONS. THE ORGANIZATION'S BYLAWS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. UNAUDITED FINANCIAL STATEMENTS OF THE ORGANIZATION ARE FILED AND VIEWABLE BY THE PUBLIC AT THE OFFICIAL WEBSITE OF THE STATE OF FLORIDA, DIVISION OF CONSUMER SERVICES. IN ADDITION, THE ORGANIZATION REPORTS ITS FINANCIAL PERFORMANCE EACH YEAR IN ITS ANNUAL REPORT, COPIES OF WHICH ARE AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part XI, Line 9 Other changes in net assets or fund balances change in fair value of split interest agreement - -19373; Form 990, Part XII, Line 2c Change of oversight process or selection process Hospice Foundation INC is part of the Chapters Health System, Inc. and Subsidiaries consolidated financial statements and therefore the audit is supervised by Chapters health System, Inc.'s audit committee. HERNANDO PASCO HOSPICE INC 12470 TELECOM DRIVE suite 300 TEMPLE TERRACE FL 33637 592217929 hospice care FL 501(c)(3 9 CHS false CHAPTERS HEALTH SYSTEM INC 12470 TELECOM DRIVE suite 300 TEMPLE TERRACE FL 33637 592264957 PARENT FL 501(c)(3 Type II NA false LIFEPATH HOSPICE INC 12470 TELECOM DRIVE suite 300 TEMPLE TERRACE FL 33637 205276870 HOSPICE CARE FL 501(c)(3 9 CHS false JUDGE ALVA CARVER FOUNDATION INC 12470 TELECOM DRIVE suite 300 TEMPLE TERRACE FL 33637 200187631 SUPPORT FL 501(c)(3 PF CHS false CHAPTERS HEALTH HOME CONNECT INC 12470 TELECOM DRIVE suite 300 TEMPLE TERRACE FL 33637 275158323 LONG-TERM CARE FL 501(c)(3 9 CHS false GOOD SHEPHERD HOSPICE INC 12470 TELECOM DRIVE SUITE 300 TEMPLE TERRACE FL 33637 205276923 HOSPICE CARE FL 501(c)(3 9 CHS false false true false false false false false false false false false false false true true false false false false